Palisaded neutrophilic and granulomatous dermatitis

{{short description|Connective tissue disease}}

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Palisaded neutrophilic and granulomatous dermatitis (PNGS) is usually associated with a well-defined connective tissue disease, lupus erythematosus or rheumatoid arthritis most commonly, and often presents with eroded or ulcerated symmetrically distributed umbilicated papules or nodules on the elbows.James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 181. {{ISBN|0-7216-2921-0}}.{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}

Signs and symptoms

Typical clinical manifestations include erythematous to violaceous plaques that are symmetrically distributed, skin-colored linear cords involving the lateral trunks, and skin-colored or erythematous papules with crusting, perforation, or umbilication.{{cite journal | last1=Zabihi-pour | first1=Dorsa | last2=Bahrani | first2=Bahar | last3=Assaad | first3=Dalal | last4=Yeung | first4=Jensen | title=Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report | journal=SAGE Open Medical Case Reports | publisher=SAGE Publications | volume=9 | year=2021 | issn=2050-313X | doi=10.1177/2050313x20979560 | page=2050313X2097956| pmid=33628445 | pmc=7882758 }}

Causes

Palisaded neutrophilic and granulomatous dermaititis is associated with subacute bacterial endocarditis,{{cite journal | last1=Deen | first1=Jacqueline | last2=Banney | first2=Leith | last3=Perry-Keene | first3=Joanna | title=Palisading neutrophilic and granulomatous dermatitis as a presentation of Hodgkin lymphoma: A case and review | journal=Journal of Cutaneous Pathology | publisher=Wiley | volume=45 | issue=2 | date=December 11, 2017 | issn=0303-6987 | doi=10.1111/cup.13076 | pages=167–170| pmid=29226345 | s2cid=43221453 }} ledipasvir/sofosbuvir,{{cite journal | last1=Shenk | first1=Mary Elizabeth Reed | last2=Ken | first2=Kimberly Marie | last3=Braudis | first3=Kara | last4=Fernandez | first4=Kristen Heins | title=Palisaded neutrophilic and granulomatous dermatitis associated with ledipasvir/sofosbuvir | journal=JAAD Case Reports | publisher=Elsevier BV | volume=4 | issue=8 | year=2018 | issn=2352-5126 | doi=10.1016/j.jdcr.2018.06.025 | pages=808–810| pmid=30246134 | pmc=6141673 }} allopurinol,{{cite journal | last1=Gordon | first1=Katherine | last2=Miteva | first2=Maria | last3=Torchia | first3=Daniele | last4=Romanelli | first4=Paolo | title=Allopurinol-induced palisaded neutrophilic and granulomatous dermatitis | journal=Cutaneous and Ocular Toxicology | publisher=Informa UK Limited | volume=31 | issue=4 | date=January 18, 2012 | issn=1556-9527 | doi=10.3109/15569527.2011.647180 | pages=338–340| pmid=22250812 | s2cid=207619806 }} Hodgkin’s and non-Hodgkin’s lymphoma, chronic myelomonocytic leukemia,{{cite journal | last1=Kyriakou | first1=Aikaterini | last2=Patsatsi | first2=Aikaterini | last3=Papadopoulos | first3=Vassilios | last4=Kioumi | first4=Anna | last5=Efstratiou | first5=Ioannis | last6=Lazaridou | first6=Elizabeth | title=A case of palisaded neutrophilic granulomatous dermatitis with subsequent development of chronic myelomonocytic leukemia | journal=Clinical Case Reports | publisher=Wiley | volume=7 | issue=4 | date=February 20, 2019 | issn=2050-0904 | doi=10.1002/ccr3.2072 | pages=695–698| pmid=30997066 | pmc=6452460 }} ulcerative colitis,{{cite journal | last1=Coutinho | first1=Inês | last2=Pereira | first2=Neide | last3=Gouveia | first3=Miguel | last4=Cardoso | first4=José Carlos | last5=Tellechea | first5=Oscar | title=Interstitial Granulomatous Dermatitis | journal=The American Journal of Dermatopathology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=37 | issue=8 | year=2015 | issn=0193-1091 | doi=10.1097/dad.0000000000000288 | pages=614–619| pmid=25830722 | s2cid=8324194 }} Takayasu arteritis, systemic vasculitis, systemic lupus erythematosus (SLE),{{cite journal | last1=Terai | first1=S | last2=Ueda-Hayakawa | first2=I | last3=Nguyen | first3=C T H | last4=Ly | first4=N T M | last5=Yamazaki | first5=F | last6=Kambe | first6=N | last7=Son | first7=Y | last8=Okamoto | first8=H | title=Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works | journal=Lupus | publisher=SAGE Publications | volume=27 | issue=14 | date=October 30, 2018 | issn=0961-2033 | doi=10.1177/0961203318809892 | pages=2220–2227| pmid=30376790 | s2cid=53108791 }} sarcoidosis,{{cite journal | last1=Kwon | first1=Eun J. | last2=Hivnor | first2=Chad M. | last3=Yan | first3=Albert C. | last4=Forbes | first4=Brian | last5=Elenitsas | first5=Rosalie | last6=Albert | first6=Dan | last7=Pawel | first7=Bruce | last8=Honig | first8=Paul | last9=Pessler | first9=Frank | title=Interstitial Granulomatous Lesions as Part of the Spectrum of Presenting Cutaneous Signs in Pediatric Sarcoidosis | journal=Pediatric Dermatology | publisher=Wiley | volume=24 | issue=5 | year=2007 | issn=0736-8046 | doi=10.1111/j.1525-1470.2007.00508.x | pages=517–524| pmid=17958801 | s2cid=30684569 }} rheumatoid arthritis,{{cite journal | last1=Sangueza | first1=Omar P. | last2=Caudell | first2=Misty D. | last3=Mengesha | first3=Yebabe M. | last4=Davis | first4=Loretta S. | last5=Barnes | first5=Cheryl J. | last6=Griffin | first6=Julia E. | last7=Fleischer | first7=Alan B. | last8=Jorizzo | first8=Joseph L. | title=Palisaded neutrophilic granulomatous dermatitis in rheumatoid arthritis | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=47 | issue=2 | year=2002 | issn=0190-9622 | doi=10.1067/mjd.2002.124620 | pages=251–257| pmid=12140472 }} eosinophilic granulomatosis with polyangiitis, chronic uveitis, and adult-onset Still’s disease.

Treatment

The underlying illness is the main focus of PNGD treatment. Up to 20% of patients may experience spontaneous resolution of the lesions. Topical corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs), dapsone, prednisone, colchicine, oral tacrolimus, and TNF inhibitors are among the available treatment options.

See also

References

{{reflist}}

Further reading

  • {{cite journal | last1=Kalen | first1=Jessica E. | last2=Shokeen | first2=Divya | last3=Ramos-Caro | first3=Francisco | last4=Motaparthi | first4=Kiran | title=Palisaded neutrophilic granulomatous dermatitis: Spectrum of histologic findings in a single patient | journal=JAAD Case Reports | publisher=Elsevier BV | volume=3 | issue=5 | year=2017 | issn=2352-5126 | doi=10.1016/j.jdcr.2017.06.010 | pages=425–428 | pmid=28932786 | pmc=5594233 | ref=none}}
  • {{cite journal | last1=Bremner | first1=Rebecca | last2=Simpson | first2=Eric | last3=White | first3=Clifton R. | last4=Morrison | first4=Lynne | last5=Deodhar | first5=Atul | title=Palisaded neutrophilic and granulomatous dermatitis: An unusual cutaneous manifestation of immune-mediated disorders | journal=Seminars in Arthritis and Rheumatism | publisher=Elsevier BV | volume=34 | issue=3 | year=2004 | issn=0049-0172 | doi=10.1016/j.semarthrit.2004.06.001 | pages=610–616 | pmid=15609265 | ref=none}}